Translaryngeal tracheostomy: two modified techniques versus the basic technique - early experience in 75 critically ill adults

Objectives: Elective tracheostomy is an established procedure in the manage ment of ICU patients on long-term ventilation. In addition, percutaneous tr acheostomy techniques are increasingly being used. In 1997, Fantoni's trans laryngeal technique (TLT), another minimally invasive procedure, was introd uced. While clinical studies of TLT showed that the technique is safe and c an be performed rapidly, technical difficulties which sometimes led to prol onged operating times were also noted. Our study compared the basic TLT tec hnique to a modified TLT approach and to TLT performed with the manufacture r's new, improved "Straight Cannula" set. Twenty-five patients were enrolle d in each group, and the advantages and disadvantages of the respective tec hniques were evaluated. Setting: Surgical ICU of a university hospital. Patients: Seventy-five adult, surgical intensive care patients. Measurements and results: Average operating times with the modified TLT tec hniques were significantly shorter, 4 and 5 min respectively, as compared t o 11 min for the basic TLT technique. Initially, use of the new, improved T LT set resulted in a complete passage of the tracheal cannula in two patien ts; uneventful Griggs's tracheostomy was performed instead. Regardless of t he technique used, no other perioperative complications were noted and the perioperative gas exchange remained unaffected by the tracheostomy procedur e. Conclusions: The modified TLT procedures are safer and more readily perform ed than the basic technique. Difficulty in the retrograde passage of the gu ide wire was seen only occasionally with the modified techniques. Based on our data we conclude that the modified techniques are superior to the basic technique and represent significant progress in TLT.